Stereotactic radiosurgery in symptomatic circumscribed choroidal hemangiomas

To evaluate visual outcomes following stereotactic radiosurgery (SRS) in patients with symptomatic circumscribed choroidal hemangioma (cCH). This retrospective study included 30 patients with symptomatic cCH treated with SRS between 2014 and 2025. SRS was performed using either the CyberKnife or ZAP-X platform depending on the treatment period. Visual outcomes were assessed by changes in best-corrected visual acuity (BCVA). A lower score on the logarithm of the minimum angle of resolution (logMAR) scale indicates better vision. The median patient age was 46 years. Ten patients (33.3%) were treatment-naive, while 20 (66.7%) had prior therapies. A single-fraction dose of 10 Gy was delivered in 29 patients (96.7%), and one patient received 14 Gy. Median BCVA improved from 1.9 logMAR (range, 0.1–3.0) at baseline to 1.3 logMAR (range, 0.1–3.0) after SRS (p = 0.01). Among 26 patients with baseline subretinal fluid, 12 (46.1%) showed complete and 10 (38.5%) partial resolution. Of six patients with retinal detachment (RD), three (50.0%) achieved anatomical resolution, but only one showed visual improvement. Logistic regression suggested a trend toward reduced likelihood of visual improvement after SRS in patients with baseline RD (OR: 0.121, p = 0.063). No clinically significant acute toxicity was observed. Two patients (6.7%) experienced grade 3 late visual acuity decrease, associated with foveal atrophy despite favorable anatomical response. SRS appears to be a safe and effective treatment for symptomatic cCH, providing visual improvement or stabilization in most cases. However, baseline RD may predict poorer visual outcomes, even with anatomical recovery. Early diagnosis and timely treatment may help optimize visual results and guide patient selection.